Yale: Avoiding Estrogen Led To Thousands Of Needless Deaths

Hormone Could Have Saved Lives Of Women With Hysterectomies, Study Finds

July 18, 2013|BY WILLIAM WEIR, bweir@courant.com, The Hartford Courant

A Yale study published Thursday states that a backlash against estrogen therapy has led to thousands of unnecessary deaths of women, specifically women who had hysterectomies.

The study, published in the American Journal of Public Health, suggests that concerns about estrogen have scared away many women who would benefit from the hormone. As a result, the researchers estimated, 42,292 to 48,835 women ages 50 to 69 who had had their uteruses removed died between 2002 and 2012 because of avoiding estrogen.

Many menopausal women stopped using estrogen therapy after the Women's Health Initiative published an expansive study in 2002 on its health effects. The 2002 study found that hormone therapy combining estrogen and progestin increased health risks for healthy women.

"The media impact was immediate, widespread and persistent," the authors of the new study wrote.

Dr. Philip M. Sarrel, who led the Yale study, said the report by the Women's Health Initiative's report was solid, but the public overgeneralized the results.

"The culprit is progestin, there's not a question in my mind," Sarrel said Wednesday.

The 2002 study included only women with uteruses who took estrogen and progestin, a synthetic hormone that decreases the risk of uterine cancer.

For the women in the 2002 study, he said, avoiding estrogen and progestin therapy was probably a good idea. As the study showed, women who took estrogen to stave off symptoms of menopause such as hot flashes and osteoporosis faced an increased risk of breast cancer, blood clots, stroke and heart disease. But the women were also taking progestin.

The 2002 study did not include women who had undergone a hysterectomy — the surgical removal of a uterus — whose hormone therapy had no reason to include progestin. Nonetheless, estrogen-only therapy for this group has dropped dramatically in the last 10 years in the backlash against hormone therapy in general. Before the 2002 study was published, 90 percent of women who had hysterectomies were on hormone therapy. Now, it's less than 10 percent.

The same organization that published the 2002 study also published studies between 2004 and 2012 indicating that estrogen-only therapy for women who had their uteruses removed decreased their risk of breast cancer and heart disease. But, Sarrel said, the impact of the Women's Health Initiative's 2002 study had been so great that, by the time estrogen's benefits were becoming obvious to researchers, negative public perception of hormone therapy had taken on great force. He compared it to a roller coaster on a downward slope.

"It's been drummed into their minds that estrogen causes breast cancer, and it will kill you," said Sarrel, emeritus professor in Yale's departments of Obstetrics, Gynecology & Reproductive Sciences and Psychiatry.

Sarrel said his study was triggered by a 2011 study by the Women's Health Initiative that compared post-menopausal women who took estrogen, but not progestin, to women who took a placebo. Women taking a placebo had a death rate of 13 more per 10,000, mostly from heart disease and breast cancer.

Sarrel said he wanted to find out how that translated to the number of deaths in the general population. He approached David Katz, an epidemiologist with the Yale Prevention Research Center.

"I said, 'Here's the numbers, can you figure out how many women have died?' " Sarrel said. "And their team went to work on figuring out what it all adds up to."

Dr. Peter Beller, in the obstetrics and gynecology department at Hartford Hospital, said the benefits of estrogen aren't news to him and his colleagues, but it's been an uphill battle convincing his patients.

"I work at Hartford Hospital, and I think every gynecologist who works here knows that this is true," Beller said. "But to try to get patients to take it is pretty hard to do because they hear the word 'estrogen' and they're scared of it."

Beller said the risks are increased for those who have not had hysterectomies, but forgoing hormone therapy altogether also carries risks, he said, adding that's it's a "double-edged sword." Depending on the patient's overall health and other factors, he still might recommend estrogen plus progestin for them. But not for longer than five years — that's when the increased risks tend to kick in, he said.